Global, regional and country burden of high BMI-related liver cancer among individuals aged above 70: trends from 1990 to 2021 and projections to 2044

Background

Liver cancer (LC) is a major global health concern, being the fourth leading cause of cancer-related mortality. Older adults are more susceptible, though mortality rates for those over 70 are declining. However, disability from non-communicable diseases remains high. High body mass index (BMI) is a notable risk factor for LC, with high BMI-related liver cancer (HB-LC) being a major concern.

Methods

This study utilized Global Burden of Disease (GBD) 2021 dataset to assess the impact of HB-LC on individuals aged 70 and older from 1990 to 2021, with forecasts extending to 2044. Disease burden across socio-demographic index (SDI) regions was evaluated using age-standardized disability-adjusted life years (DALYs). Joinpoint regression and age-period-cohort models were used to analyze DALY trends and demographic influences, and decomposition analysis assessed the effects of population aging, growth, and epidemiological shifts.

Results

Our findings revealed significant geographical disparities in HB-LC mortality, with East Asia, Southeast Asia, and parts of West Africa showing the highest rates. Global HB-LC DALYs increased by 2.49% annually, with low SDI regions experiencing recent acceleration. Gender disparity persisted, with males facing a steeper rise in HB-LC burden. Age-related DALY rates peaked in the 80-89 age groups, showing complex patterns across SDI regions. Epidemiological changes primarily drove the increased HB-LC burden in high SDI regions, while population growth was more significant in low SDI regions.

Conclusion

This data analysis underscores necessity for region-specific public health strategies and demographic-focused interventions, enhancing surveillance and targeting efforts to mitigate the increasing burden of HB-LC among the older adults.

Risk factors for postoperative surgical complications after inguinal lymph node dissection in penile cancer patients

Wound related and lymphatic reflow-related complications are commonly seen in penile cancer patients after inguinal lymph node dissection (ILND). However, the risk factors for them remain unclear. The objective of this study is to identify surgical-related risk factors for complications after ILND in penile squamous cell carcinoma (PSCC) patients. In this study, 192 PSCC patients aged 23-88 were enrolled between October 2008 and October 2023. Univariate analysis and logistic regression were performed to identify risk factors. Receiver operating characteristic (ROC) curves were used to analyze the relationship between certain risk factors and postoperative complications and find cut-off points for certain risk factors. Postoperative complications were observed in 87.5% of patients, with lymphatic fistula being the most common (50.0%) and wound dehiscence the least common (1.1%). Different factors were associated with each complication. Additionally, we found that the retention time of the drainage tube correlates with both lymphocele and wound infection, emphasizing the importance of optimizing drainage tube management to reduce lymphatic and wound-related complications. In conclusion, this study identified specific risk factors for complications after ILND in PSCC patients, particularly the shorter and longer retention times of the drainage tube for lymphocele and wound infection as determined by our multivariate analysis, and proposed new strategies to not only reduce the occurrence of these complications but also accelerate the postoperative healing process.

Clinical Outcome of Conversion Surgery for Stage IV Esophageal Cancer Following Chemoradiation

Purpose: We aimed to identify the impact of conversion surgery to survival in patients with stage IV esophageal cancer who have a stabilized disease and good treatment response before surgery. Patients and Methods: This retrospective study included patients with esophageal cancer M1 disease treated at a tertiary medical center from April 2002 to June 2021. For patients with a good clinical response to chemoradiation and well-controlled metastatic lesions, esophagectomy and lymphadenectomy were performed. A propensity score-matching (PSM) study with a 1:2 ratio and based on patient age, tumor stage, and metastasis status was conducted for verifying the results. Results: We enrolled 162 patients, including 124 treated with concurrent chemoradiation therapy (CCRT) alone and 38 treated with CCRT followed by esophagectomy. A total of 114 patients were analyzed using PSM, including 76 patients treated with CCRT alone and 38 patients treated with CCRT and surgery. The 3- and 5-year OS was 24.6% vs. 2.8% and 12.3% vs. 1.4% (p = 0.006), and PSM was 24.6% vs. 4.6% and 12.3% vs. 2.3% (p = 0.033) for those with or without esophagectomy, respectively. Multivariate analysis revealed surgery with esophagectomy as an independent prognostic factor for OS with odd ratios (95% confidence interval [CI]) of 1.91 (1.23-2.95) (p = 0.004). Conclusions: Surgical resection following CCRT holds a potential survival benefit for the patients with a favorable response to CCRT for patients with stage IV esophageal cancer.

Management of perforated peptic ulcer: What you need to know

ABSTRACT

Despite therapeutic advancements and the significant efficacy of medical management, peptic ulcer disease still affects millions of people. Elective surgical treatment, once a common intervention in General Surgery departments, is now nearly obsolete. Surgical treatment is reserved solely for complications, which occur in approximately 10% to 20% of cases. Perforation is the most common indication for surgery in peptic ulcer disease and accounts for nearly 40% of deaths from the disease. Treatment success depends on various factors, with early diagnosis and immediate surgical intervention being highlighted. Perforation is associated with a high incidence of morbidity and mortality. This article aims to analyze the different aspects related to the treatment of perforated peptic ulcers and define the best therapeutic approaches.

Reoperative Laparoscopic Liver Resection for Hepatolithiasis Patients With a History of Biliary Surgery: A Cohort Study

INTRODUCTION

It is unclear whether laparoscopic hepatectomy for hepatolithiasis patients with a history of biliary surgery achieves favorable clinical outcomes. This study aimed to evaluate the safety and feasibility of reoperative laparoscopic hepatectomy (rLH).

METHODS

Patients who underwent anatomical liver resection for hepatolithiasis between 2015 and 2022 were included in the study. The clinical outcomes of rLH were compared with those of reoperative open hepatectomy (rOH) and initial laparoscopic hepatectomy (iLH). To ensure balanced baseline characteristics, propensity score matching was performed.

RESULTS

A total of 311 patients undergoing anatomical hepatectomy combined with biliary exploration for hepatolithiasis were studied, which included 84 rOH, 101 rLH, and 127 iLH. Propensity score matching resulted in 86 patients in both iLH (miLH) and rLH (mrLH) groups. Compared with the miLH group, the mrLH group had a higher conversion rate (14.0% versus 3.5%, P < 0.001), a higher 90-d complication rate (52.3% versus 34.9%, P = 0.035), and a lower stone clearance rate (initial, 76.2% versus 89.9%, P = 0.024; final, 81.0% versus 93.7%, P = 0.021). However, when compared with the rOH group, the rLH group required a lower blood transfusion rate (20.8% versus 39.3%, P = 0.006), a shorter median postoperative hospital stay (8.0 versus 11.0 d, P < 0.001), and a lower stone recurrence rate (4.9% versus 25.8%, P < 0.001), except for a longer median operation duration (300.0 versus 240.0 min, P < 0.001). No significant differences were found in other clinical outcomes.

CONCLUSIONS

rLH is a safe and feasible option for selected patients with hepatolithiasis who have previously undergone biliary surgery, although its overall clinical benefit is inferior to that of iLH. It should be carefully performed by surgeons with rich experience in laparoscopic liver resection in large medical centers.

Initial Outcomes of a Novel Technique of Nipple Sparing Mastectomy Without Reconstruction

Introduction: Nipple sparing mastectomy is oncologically safe and has a good cosmetic outcome. However, nipple sparing mastectomy was conventionally performed with reconstruction. Minimal scar mastectomy (MSM) is a novel technique which could allow women, with non-ptotic breasts, who do not want reconstruction, to conserve their nipple areolar complex (NAC) and avoid the transverse scar associated with modified radical mastectomy. This is the first study on the outcomes of MSM. Methods: MSM complications and their risk factors, recurrence rates and cosmetic outcomes were assessed. As MSM is a modification of the round block technique, the mean ring distance (MRD), which is the average of the distance between the inner and outer ring circumferentially, was assessed, too. Results: A total of 28 patients (29 breasts) were analysed. There was no recurrence after a mean/median follow-up of 40.3/41 months (4-80 months). In the initial recruitment of 17 patients (18 breasts), NAC necrosis occurred in eight cases (three complete, five partial). Prediabetes (p = 0.0128) and MRD ≥1.5 cm (p = 0.0440) were statistically significant for NAC necrosis. Of the available data, 11/15 (73.3%) rated the cosmetic outcome as excellent/good, with poorer cosmetic outcome correlated with NAC necrosis (p = 0.006). Avoiding the above risk factors in the next 11 patients, NAC necrosis decreased to 1/11 (9.0%) with mild ischaemia. Cosmetic outcome was rated as excellent/good in 90.9%. Conclusions: MSM is oncologically safe and is best performed in patients with no risk factors for NAC necrosis, including prediabetes and MRD < 1.5 cm. These pilot results will refine the selection criteria of patients for MSM.

Anterior rotation of the temporalis muscle for prevention of temporal hollowing in cranial surgeries: Esthetic and patient-reported outcomes

Background

Temporal hollowing is a common cosmetic complication following pterional craniotomies. To address this issue, we evaluated the efficacy of anterior rotation of the temporalis muscle at closure. Although this technique is not new and has been generally reported, no research studies have been conducted to evaluate its objective and patient-reported outcomes in the long term.

Methods

We retrospectively reviewed 22 patients treated with pterional, fronto-orbitozygomatic, or frontotemporo-zygomatic craniotomies from March 2021 to 2023. A 12-month postoperative magnetic resonance imaging was used to evaluate the degree of temporal hollowing. To quantify temporal hollowing, we measured the distance of depression at the level of the temporal fossa. This distance, or "temporal thickness," was defined as the widest distance between the skull's outer cortical bone and skin surfaces at the level of the anterior clinoid process (D1) and foramen of Monro (D2). Furthermore, pre and postoperative cosmetic results were evaluated using the Rostock Functional and Cosmetic Cranioplasty (RFCC) Score. For reasons of objectivity, RFCC was tested by two independent plastic surgeons against the patient's rating.

Results

After a year or more follow-up, 54.5% of patients exhibited no hollowing, while 31.8% had mild or moderate hollowing. Moreover, 91% reported good esthetic outcomes. No cases of severe hollowing were observed. Importantly, temporomandibular joint dysfunction was not observed.

Conclusion

These results suggest that anterior rotation of the temporalis muscle is an effective primary strategy to mitigate cosmetic deformities without compromising masticatory function. Further studies with larger sample sizes are warranted to confirm these findings.

Low serum calcium promotes traumatic intracerebral hematoma expansion by the response of immune cell: A multicenter retrospective cohort study

To explore the potential role of serum calcium levels at admission in the expansion of acute traumatic intracerebral hematoma (tICH) and to construct a novel nomogram to predict tICH expansion. In this multicenter retrospective study, 640 and 237 patients were included in the training and validation datasets, respectively. Risk factors for acute tICH expansion were selected by logistic regression analysis. Causal mediation and interaction analysis were used to explore the relationship between serum calcium promotion of tICH expansion and inflammatory response. Receiver operating characteristic, calibration and clinical decision curves were applied to estimate the performance of multivariate models. Low serum calcium level was strongly associated with acute tICH expansion in patients with brain contusion. There was no significant interaction of hypocalcemia across multiple subgroups including sex, age, and coagulation dysfunction. 24.5% of the mechanisms by which hypocalcemia promotes acute tICH expansion can be explained by an inflammatory response. The addition of serum calcium made the modified model (serum calcium plus basic model) more accurate than basic model with subdural hematoma, multihematoma fuzzy sign, time to baseline CT, level on Glasgow Coma Scale score, platelet count, baseline tICH volume ≥ 5 mL, and monocyte-to-lymphocyte ratio. Low serum calcium level is a novel risk factor for acute tICH expansion, the mechanism of which may be mediated in part through the response of immune cell. The online dynamic nomogram provides a user-friendly tool for the prediction of acute tICH expansion.

Surgical Resection of Vascular Anomalies of the Upper Extremity-An Observational Study

Background/Objectives: This study aimed to investigate surgical resections of vascular malformations and haemangiomas of the upper extremity, pre- and postoperative symptoms, complications and recurrences. Methods: A total of 82 patients with vascular malformations and haemangiomas treated by surgical resection from 2010 to 2020 were included in this observational study. Pre- and postoperative symptoms, including pain and swelling, as well as complications and recurrence rates, were assessed. Descriptive statistics were provided for all reported data. Parametric and non-parametric tests were used for group comparisons. Alterations of reported pain were assessed. A two-sided alpha of 5% determined statistical significance. Results: A total of 88 procedures were performed in 82 patients. The most common vascular malformation was a venous malformation, followed by arterio-venous malformations. More than 50% of the patients reported pain prior to the surgery, while 14.6% of patients experienced pain postoperatively, which indicated significant improvement (p = 0.001). Minor postoperative complications occurred in 31.7% of patients. Overall, a recurrence rate of 17.1% was recorded during postoperative follow-up, mostly occurring in diffuse and infiltrating types of vascular malformations. Conclusions: Surgical resections of vascular anomalies of the upper extremity led to symptom improvement and are an important part of the multidisciplinary treatment algorithm.

Global burden of lung cancer attributable to metabolic and dietary risk factors: an overview of 3 decades and forecasted trends to 2036

Background

Lung cancer (LC) is the leading cause of cancer-related burden worldwide. Unhealthy dietary patterns and related metabolic diseases, such as diabetes mellitus (DM), represent critical global public health challenges. Nevertheless, the global burden of LC attributable to metabolic and dietary factors remains uncertain.

Methods

This study aims to analyze global burden of LC attributable to metabolic and dietary risk factors, based on the Global Burden of Disease (GBD) 2021, from 1990 to 2021. Additionally, the autoregressive integrated moving average (ARIMA) model was utilized to forecast the disease burden of LC for the upcoming 15-year period.

Results

High fasting plasma glucose (HFPG) and Diet low in fruits (DLF) are identified as the sole metabolic and dietary risk factors for LC, respectively, according to GBD 2021. The study findings indicate that a marked increase in the LC burden caused by HFPG, whereas the age-standardized rates (ASRs) of mortality and disability-adjusted life-years (DALYs) attributable to DLF for LC represent a general decline. At the social population index (SDI) regional level, the burden of LC attributable to DLF represents the most rapid increase in low-middle SDI regions, and while, the burden of LC attributable to DLF exhibits the most rapid decline in high-middle SDI regions. Moreover, LC burden attributable to HFPG and DLF in mortality and DALYs is higher among males than females, with sex difference being more pronounced in the elderly.

Conclusion

From 1990 to 2021, the burden of LC attributed to HFPG has increased owing to the escalating exposure levels of DM, whereas the burden resulting from DLF has declined. The burden of LC attributable to HFPG and DLF exhibits distinct spatiotemporal patterns and similar gender-age patterns.

Elastic stable intramedullary nails compared to locking compression plates for treating unstable distal ulnar fractures in adults: a prospective comparative study

BACKGROUND AND PURPOSE

Distal ulna fractures often occur in conjunction with distal radius fractures and other associated injuries. Currently, there are no satisfactory internal fixation systems available for addressing unstable distal ulna fractures, and a definitive consensus on the most effective treatment approach is still lacking. The objective of this research was to evaluate the clinical outcomes of using elastic stable intramedullary nails (ESIN) compared to locking compression plates (LCP) for treating unstable distal ulnar fractures in adults.

METHODS

In a prospective clinical study, a total of 54 patients (21 females and 33 males; average age 49.3 years, ranging from 30 to 63 years) suffering from unstable or displaced fractures of the distal ulna were randomly allocated to one of two treatment groups between January 2021 and August 2024. Specifically, 26 patients underwent treatment utilizing elastic stable intramedullary nails, whereas 28 patients were managed using locking compression plates. The two groups were evaluated prospectively for perioperative data and functional results.

RESULTS

The ESIN group comprised 26 patients, exhibiting a mean age of 48.27 years (with a range of 30 to 62 years), while the LCP group included 28 patients, whose mean age was 50.33 years (ranging from 32 to 63 years). Both groups were comparable regarding gender distribution, side of injury, mechanisms of injury, and classifications of fractures. However, there were significant differences noted in incision length of the ulna, surgical duration, frequency of fluoroscopy, and the rates of excellent and good functional outcomes as measured by the Gartland-Werley scores between the two groups (P < 0.05). Conversely, no significant differences were found concerning the time to union and the duration of immobilization between the two groups (P > 0.05).

CONCLUSION

ESIN offers several advantages, including reduced incision length, lower frequency of fluoroscopy, shorter duration of the surgical procedure, decreased complication rates, and improved Gartland-Werly scores. Therefore, fixation using ESIN serves as an effective alternative for the treatment of distal ulnar fractures in adults. The minimally invasive nature and lower complication rates are defining characteristics of ESIN fixation.

Prevalence and Factors with Potentially Inappropriate Prescribing among Older Surgical Outpatients in China: A Nationwide Cross-sectional Study in 100 Hospitals

BACKGROUND

Older outpatients face a heightened risk of potentially inappropriate prescribing (PIP). However, there is a paucity of evidence evaluating PIP in older outpatients attending surgical outpatient departments in China using Chinese-specific criteria. This study aimed to assess the prevalence of PIP and identify associated factors within this population.

METHODS

A cross-sectional design was employed, utilizing prescription data from older surgical outpatients across 100 hospitals in seven Chinese cities between January and December 2021. PIP was assessed based on Chinese criteria, and multivariate logistic regression analysis was performed to identify risk factors. Trends were analyzed using the average annual percent change (AAPC) via joinpoint regression.

RESULTS

A total of 357,135 prescriptions for older surgical outpatients were analyzed. The prevalence of PIP according to Chinese criteria was 13.06%. The five most commonly identified potentially inappropriate medications (PIMs) were doxazosin, clopidogrel, tolterodine, estazolam, and the concurrent use of more than two NSAIDs, which together accounted for 52.73% of all PIMs. From January to December, the prevalence of PIP exhibited a slight decrease, from 13.29 to 13.21% (AAPC: -0.278%). Logistic regression revealed that factors such as tertiary-level hospital status, polypharmacy, pain, sleep disorders, hypertension, benign prostatic hyperplasia, and stone disease were positively associated with PIP in older surgical outpatients.

CONCLUSIONS

The study found that while the prevalence of PIP among older surgical outpatients in China is relatively low, attention is needed to the widespread use of certain PIMs.

Long-Term Outcomes of Local Tumor Destruction/Excision Versus Total Hysterectomy for Stage IA Cervical cancer: A Retrospective Study Based on the SEER Database

Background

A growing number of patients with early-stage cervical cancer opt for local tumor resection to preserve the uterus. Nevertheless, there is still a dearth of long-term comparisons between local tumor destruction/excision (LTD/LTE) and total hysterectomy(TH), and the optimal target population for local tumor excision remains uncertain.

Methods

A multicenter retrospective study utilizing the Surveillance, Epidemiology, and End Results (SEER) database to compare the long-term outcomes between LTD/LTE and TH in stage IA cervical cancer patients was conducted. A 1:1 propensity score matching (PSM) method was employed to obtain matched cohorts with similar baseline characteristics in the LTD/LTE and TH groups. Kaplan-Meier analysis was used to compare overall survival (OS) and cancer-specific survival (CSS) between the two groups. The Cox proportional hazard models were employed to identify factors associated with OS and CSS.

Results

This study comprised a total of 6382 cervical cancer patients, with 1759 undergoing LTD/LTE and 4623 undergoing TH. After PSM, a significant difference was observed in OS (P=0.030) between the two groups, while no significant difference was found in CSS (P=0.110). Subgroup analysis of patients with stage IA1 (OS: P=0.018; CSS: P=0.230) and IA2 (OS: P=0.071; CSS: P=0.240) revealed no significant differences in OS and CSS between the two groups. Older age (≥50 years) [HR=2.20; 95% CI: 2.20-3.30)] and histological types other than squamous cell carcinoma and usual-type adenocarcinoma [HR=4.40; 95% CI:1.80-11.10] favored TH for better OS, whereas well-differentiated (grade I-II) [HR=0.40; 95% CI: 0.20-0.90] patients were more suitable for LTD/LTE, leading to improved OS and CSS outcomes.

Conclusion

It was determined that the long-term outcomes of LTD/LTE are comparable to TH and can serve as a safe option for selected patients with stage IA cervical cancer. Future large prospective studies are required to validate our findings and explore differences in recurrence patterns between the two treatment strategies.

Cell death in tumor microenvironment: an insight for exploiting novel therapeutic approaches

Cell death is critical in tumor biology. The common cancer therapies can cause cell death and alleviate tumor, while the cancer cells can develop a resistance to cell death and survive from the therapies. Thus, not only observing the alternative mechanisms of tumor cells resistant to cell death, but also understanding the intricate dynamics of cell death processes within the tumor microenvironment (TME), are essential for tailoring effective therapeutic strategies. High-throughput sequencing technologies have revolutionized cancer research by enabling comprehensive molecular profiling. Recent advances in single cell sequencing have unraveled the heterogeneity of TME components, shedding light on their complex interactions. In this review, we explored the interplay between cell death signaling and the TME, summarised the potential drugs inducing cell death in pre-clinical stage, reviewed some studies applying next-generation sequencing technologies in cancer death research, and discussed the future utilization of updated sequencing platforms in screening novel treatment methods targeted cell death. In conclusion, leveraging multi-omics technologies to dissect cell death signaling in the context of the TME holds great promise for advancing cancer research and therapy development.

Nanomaterial-enabled anti-biofilm strategies: new opportunities for treatment of bacterial infections

Biofilms play a pivotal role in bacterial pathogenicity and antibiotic resistance, representing a major challenge in the treatment of bacterial infections. The limited diffusion and inactivation efficacy of antibiotics within biofilms hinder their clearance, and while increasing dosage may enhance effectiveness, it also promotes antibiotic resistance. Nano-delivery systems that target antimicrobial agents directly to biofilms offer a promising strategy to overcome this challenge. This review summarizes the resistance mechanisms and therapeutic challenges associated with biofilms, with a focus on recent advances in nano-delivery systems such as liposomes, nanoemulsions, cell membrane vesicles (CMVs), polymers, dendrimers, nanogels, inorganic nanoparticles, and metal-organic frameworks (MOFs). Furthermore, the review explores the potential applications and challenges of nano-delivery systems in biofilm treatment and provides recommendations to guide future research and development in this field.

Global, regional, and national burden and trends of stroke among youths and young adults aged 15-39 years from 1990 to 2021: findings from the Global Burden of Disease study 2021

Background

Stroke is a leading cause of disability and mortality worldwide, with rising incidence rates among youths and young adults aged 15-39 years. However, comprehensive assessments of stroke burden in this age group at global, regional, and national levels are limited. This study examines trends in stroke incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 using data from the Global Burden of Disease (GBD) study.

Methods

Data from the GBD study (1990-2021) were analyzed to assess the age-standardized incidence, mortality, and DALYs related to stroke in individuals aged 15-39 years. The relationship between stroke burden and the Socio-Demographic Index (SDI) was explored across 204 countries and 21 regions. Trends were analyzed using the estimated annual percentage change (EAPC) and average annual percentage change (AAPC).

Results

This study reveals global, regional, and national trends in stroke burden among youths and young adults (15-39 years) from 1990 to 2021. In 2021, the global age-standardized stroke incidence was 757,234.61 cases, with 8.72 million DALYs and 122,742 stroke-related deaths. Although global incidence increased by 19.09%, age-standardized rates (ASRs) declined by 0.67% annually. DALYs and mortality rates also decreased globally. Notably, stroke burden increased in low and low-middle SDI regions. South Asia had the highest number of cases, while Oceania reported the highest mortality rate. These findings underscore regional disparities in stroke trends. Globally, metabolic risks (46.2%) and high systolic blood pressure (37.87%) are major contributors to stroke-related mortality.

Controlling nutritional status score predicts posthepatectomy liver failure: an online interpretable machine learning prediction model

BACKGROUND AND AIMS

Posthepatectomy liver failure (PHLF) remains a severe complication after hepatectomy for hepatocellular carcinoma (HCC) and accurate preoperative evaluation and predictive measures are urgently needed. We investigated the impact of the controlling nutritional status (CONUT) score on PHLF and utilized machine learning (ML) algorithms to identify high-risk individuals of PHLF.

METHOD

A total of 464 patients with HCC undergoing hepatectomy were randomized 7 : 2: 1 into the training group (n = 324), test group (n = 96), and validation group (n = 46). In the training group, variables were screened by univariate logistic regression combined with least absolute shrinkage and selection operator regression. Models were then developed using nine ML algorithms and the optimal model was interpreted via SHapley Additive exPlanations and deployed online.

RESULTS

PHLF was present in 29 of 324 (8.9%) patients. The light gradient boosting machine (LightGBM) model based on the CONUT score exhibited excellent performance, with an area under the curve (AUC) of 0.927 [95% confidence interval (CI): 0.886-0.967], an area under the precision-recall curve (AUPRC) of 0.644 (95% CI: 0.469-0.785), and a Brier score of 0.055 in the training group. And an AUC of 0.703 (95% CI: 0.528-0.879), an AUPRC of 0.420 (95% CI: 0.096-0.703), and a Brier score of 0.091 in the test group. In the validation group, AUC, AUPRC, and Brier score were 0.808 (95% CI: 0.637-0.980), 0.516 (95% CI: 0.086-0.841), and 0.096, respectively. The model was made available online for clinical application (LightGBM for PHLF).

CONCLUSION

The CONUT score significantly influences PHLF. The LightGBM model demonstrates the prominent predictive capacity of PHLF.

Case report: Free autologous costal cartilage transplantation for osteochondral lesions of the talus: three cases with 2-5 years follow-up

Background

Osteochondral lesions of the talus (OLT) is a common and clinically challenging condition with no consensus on the optimal treatment. The prospective case series aim to evaluate the feasibility and clinical outcomes of free autologous costal cartilage transplantation (ACCT) for OLT.

Methods

From April 2018 to October 2022, three patients who were diagnosed with OLT underwent free ACCT. Demographic characteristics, including age, gender, lesion size and location were collected at baseline. Functional and imaging outcomes were evaluated at 1 year, 2 years, and 5 years postoperatively. The primary outcomes were American Orthopedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Ability Measure (FAAM) score. Secondary outcomes included Numeric Rating Scale (NRS), Tegner Activity Scale, and evaluations of images. A paired t-test was used for preoperative and postoperative comparison of the paired-design dataset.

Results

Three patients (37.33 ± 16.50 years old) were included in the study with 2-5 years follow-up. AOFAS score improved from 60 ± 11 at baseline to 96 ± 6.93 at 2 years (p < 0.01) and 94 ± 8.49 at 5 years. FAAM/ADL improved from 60.97 ± 6.58 at baseline to 98 ± 1.83 at 2 years (p < 0.01) and 97 ± 0.85 at 5 years. FAAM/Sports improved from 56.4 ± 11.95 at baseline to 88.23 ± 11.34 at 2 years (p < 0.01) and 89 ± 4.67 at 5 years. Other functional scores in patient reported outcomes also showed significant improvements. Postoperative CT and MRI showed complete defect filling and robust tissue integration after ACCT. Arthroscopic evaluations further confirmed solid integration of costal cartilage into the underlying subchondral bone with a smooth surface over the repair site.

Conclusion

Free ACCT is a feasible method for improving ankle function and quality of life for at least 2 years in patients with OLT. Promising long-term outcomes may be possible because of the good integration between the recipient talus and the implanted ACCT.

Regional patterns of early-onset colorectal cancer from the GEOCODE (Global Early-Onset COlorectal Cancer DatabasE)-European consortium: retrospective cohort study

BACKGROUND

The incidence of early-onset colorectal cancer is increasing, but in Europe this growth shows a heterogeneous pattern in different countries and regions.

METHODS

Patients from six countries who participated in the Global Early-Onset COlorectal Cancer DatabasE (GEOCODE)-Europe group were included. The inclusion criteria were patients with colorectal adenocarcinoma diagnosed between 18 and 49 years of age, between January 2010 and December 2017, with at least 3 years of follow-up. Patients with inherited colorectal cancer syndromes were excluded.

RESULTS

A total of 851 patients were included with almost equal sex distribution, most were diagnosed at age 39 years or older and 42% of patients were overweight or obese. Diagnoses were predominantly at later stages (62.5% stage III-IV) and tumours were predominantly located in the distal colon (76.9% left colon and rectum). Comparative analysis between countries demonstrated that the UK had a younger age at diagnosis and the Italian cohort had a higher prevalence of being overweight or obese. Patients from Luxembourg had more advanced stage diagnoses and those from The Netherlands had more polyps. Patients from the UK had a greater family history of colorectal cancer. Comparison of Mediterranean versus non-Mediterranean countries showed significant differences in the age at diagnosis and body mass index. The prevalence of early-onset colorectal cancer over the age of 40 years in Mediterranean versus non-Mediterranean countries was 71.4% versus 62.1% (P = 0.002), and early-onset colorectal cancer was diagnosed at a more advanced stage in Mediterranean countries versus non-Mediterranean countries (65.3% versus 54.7%; P = 0.033). Family history of colorectal cancer in a first-degree relative was more common in non-Mediterranean versus Mediterranean countries (19.1% versus 11.4%; P < 0.001).

CONCLUSION

This study highlights significant geographical disparities in the clinical, pathological and familial features of early-onset colorectal cancer across European countries.

Hidden costs of surgical complications: a retrospective cohort study

Objectives

To quantify how surgical complications impact hospital revenue when their effect on the volume of admissions is considered.

Design

Retrospective analysis of comprehensive administrative data.

Setting

Three university hospitals in France.

Participants

54 637 inpatient stays between 2017 and 2023 in 4 surgical departments (abdominal, orthopedics, thoracic, and urology).

Main outcome measures

Stays were categorized by their diagnosis-related group and occurrence of one or more complications, according to International Classification of Diseases, 10th revision diagnosis codes. First, data were aggregated monthly to determine the impact of variation in the monthly mean length of stay (LOS) on the monthly volume of admissions, using an instrumental variable strategy. Second, LOS and revenue per patient were compared for patients with and without complications. Finally, an estimation of the impact of complications on total revenue was performed.

Results

A total of 54 637 stays were analyzed, with 9735 (17.8%) experiencing at least one complication. The mean LOS was 8.7 days and the mean revenue per patient was €7602. The instrumental variable analysis, designed to account for unobserved confounders, showed that a decrease of 10% in the monthly mean LOS increased the monthly volume of admissions by 9% (95% CI (5.1% to 13.0%), p<0.01). Complications increased the LOS by 10.9 days (95% CI: (8.95 to 13.1), p<0.01) and revenue per patient by €7912 (95% CI: (6420 to 9087), p<0.01), but decreased daily revenue per patient by €211 (95% CI: (-384 to -83.0), p<0.01). Over the study period, the estimated potential loss induced by complications ranged from 6.6% (95% CI (6.3% to 7.0%), p<0.01) to 9.1% (95% CI (8.8% to 9.4%), p<0.01) of actual revenue. Departments with higher complication rates incurred larger potential losses.

Conclusions

Surgical complications reduce total revenue by crowding out short stays that generate more daily revenue. This challenges the consensus that complications are a boon for hospital revenue, instead implying that they shrink hospital net margins (ie, revenue minus costs).

Verticillin A-Loaded Surgical Buttresses Prevent Local Pancreatic Cancer Recurrence in a Murine Model

The fungal metabolite verticillin A is a potent and selective histone methyltransferase inhibitor. It regulates apoptosis, the cell cycle, and stress response, and displays potent activity in the suppression of tumor cell growth in several different in vivo models. Verticillin A sensitizes pancreatic cancer cells to anti-PD-1 immunotherapy by regulating PD-L1 expression. However, as with many natural products, delivery and systemic toxicity are challenges that must be overcome to advance their use as a chemotherapeutic. To both reduce systemic toxicity and improve delivery, we report a verticillin A-loaded surgical buttress, which is well-tolerated at a dose as high as 40 mg/kg. In contrast, free verticillin A administered systemically results in toxicity at a dose of 3 mg/kg. The verticillin A-loaded buttress suppresses tumor recurrence in vivo in a safe and dose-dependent manner against a highly aggressive and metastatic model of pancreatic cancer.

Weighing up GnRH agonist therapy for endometriosis: outcomes and the treatment paradigm

INTRODUCTION

Endometriosis is a chronic inflammatory estrogen-dependent disease affecting 10% of women worldwide leading to chronic pelvic pain and infertility which may be treated clinically or surgically.

AREAS COVERED

Current literature was reviewed using the keywords 'gonadotropin releasing hormone agonists (GnRHa),' 'endometriosis,' 'infertility' and 'chronic pelvic pain.' Relevant papers prioritizing randomized controlled clinical trials (RCT), systematic reviews, meta-analyses, as well as international guidelines were evaluated.

EXPERT OPINION

Available options for relieving endometriosis-associated pain include GnRHa, progestagens, and combined oral contraceptives, all of which block menstruation to control symptoms without curing the disease. GnRHa administration decreases pain and symptom recurrence after surgical treatment, but side effects and costs limit its use. Published studies to test its effectiveness in easing endometriosis-associated pain are heterogeneous, consider different outcomes with no long-term results. Drug choice should be individualized considering the side-effect profile, tolerability, costs, risks, and benefits as one size does not fit all. As we wait for the development of an ideal pharmacological agents, GnRHa with an add-back regimen remains a second-line option to alleviate the painful symptoms in women with endometriosis. Endometriosis management should consider the systemic nature of the disease and the complexity involved in the pathogenesis of symptoms.

Clinical Features, Inflammatory Markers, and Limb Salvage in Older Adults with Diabetes-Related Foot Infections

Little information exists about diabetic foot infections (DFIs) in older patients. We hypothesize that older patients with DFIs have different clinical features and worse outcomes than younger patients. We conducted a prospective observational study consisting of a cohort of patients with diabetes and moderate to severe DFIs. Patients included in the cohort were dichotomized into two groups using percentile 75 (P75) of age as the cut-off value. Patients aged > P75 presented with more comorbidities and foot-related complications, a higher rate of peripheral arterial disease (PAD), worse renal function (higher values of blood urea nitrogen and creatinine, and lower values of estimated glomerular filtration rate), and lower values of HbA1c compared with younger patients. Infection severity, microbiological features, and inflammatory markers were similar in both groups. In the multivariate analysis, minor amputations were associated with age > P75 (OR = 2.8, 95% CI 1.3-5.9, p <0.01), necrosis (OR = 4.2, 95% CI 1.8-10.1, p < 0.01), and CRP values (OR = 1.045, 95% CI 1.018-1.073, p < 0.01). Major amputations were associated with a history of amputation (OR = 4.7, 95% CI 1.3-16.7, p = 0.01), PAD (OR = 4.3, 95% CI 1.2-14.6, p = 0.01), and albumin values (OR = 0.344, 95% CI 0.130-0.913, p = 0.03). In conclusion, limb salvage can be achieved in older patients with diabetes-related foot infections at the same rate as in younger patients, despite the fact that they have more comorbidities and foot-related complications, a higher rate of PAD, and worse renal function.

Rare Encounter With Hepatic Epithelioid Hemangioendothelioma: A Case Report

Malignant hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor with variable malignant potential, often affecting middle-aged individuals. Hepatic involvement is uncommon, presenting diagnostic challenges due to overlapping imaging features with other liver pathologies. We report a case of a 35-year-old female with HEHE initially presenting with epigastric pain and an incidental liver mass. Imaging revealed multifocal hepatic lesions, confirmed as HEHE through biopsy and immunohistochemistry. Despite initial stability on tamoxifen, disease progression occurred after seven years, manifesting as an increase in the size and number of hepatic lesions. Hepatic transplantation was planned, which was refused by the patient. Subsequently, the disease progressed to a large confluent hepatic mass with calcifications, lymphadenopathy, and pulmonary metastases. Systemic chemotherapy was henceforth initiated. This case underscores the importance of a multimodal approach integrating imaging, histopathology, and tailored therapeutic strategies for diagnosing and managing HEHE. Early detection and comprehensive management are critical to improving outcomes where liver transplantation offers a potential cure.

Colon obstruction due to sunflower seed bezoar: A case report

INTRODUCTION

This case report aims to present a rare case of colon obstruction caused by a bezoar in a 15-year-old teenager. The significance of this case lies in the rarity of such obstructions and the necessity for early diagnosis and appropriate intervention to optimize patient outcomes.

PRESENTATION OF CASE

A 15-year-old teenager presented with colicky abdominal pain, abdominal distension, nausea, vomiting, and rectal bleeding for three days. Initial investigations yielded normal results, but a digital rectal examination and abdominal X-ray suggested colon obstruction. The patient underwent surgical consultation and emergent laparotomy, during which a bezoar was identified and successfully removed endoscopically. Colonoscopy revealed that the bezoar was composed of shelled sunflower seeds, which correlated with the patient's dietary history.

DISCUSSION

This case highlights the rarity of bezoars causing colon obstruction. Early recognition and appropriate intervention are crucial for optimizing patient outcomes and preventing complications associated with colon obstruction.

CONCLUSION

This report highlights the importance of considering bezoars as a differential diagnosis in patients with colon obstruction. Early identification and treatment can prevent serious complications and improve clinical outcomes.

Fate of the Flexor Hallucis Longus Muscle at the Donor Site After Fibula Flap Harvest: Assessing Muscle Viability Using Novel MRI Techniques - A Cohort Study

BACKGROUND

Fibula flap dissection sacrifices the blood vessels to the flexor hallucis longus (FHL) and other calf muscles. This novel MRI study investigates perfusion and fibrosis of the FHL muscle after fibula flap harvest.

MATERIAL AND METHODS

A cohort study from September 2018 to January 2021, we prospectively recruited head and neck cancer patients who were planned to receive fibula flap transfer for jaw reconstruction. All participants received MRI before and one year after the operation. Muscle fibrosis was quantified via extracellular volume matrix fraction (ECV); muscle perfusion via time to peak (TTP), T2* change, and T2* slope by BOLD sequence. Muscle fibrosis and perfusion were compared before and after the operation.

RESULTS

Total of 18 patients completed the study (mean age: 48.83 years). Significantly increased fibrosis was seen in the postoperative FHL muscle via elevated ECV (11.23%-32.54%, p < 0.001). Despite prolonged TTP in postoperative FHL (38.17-51.83 s, p = 0.343), increased T2* change (8.43%-9.53%, p = 0.369), and increased T2* slope (0.22%-0.23%/s, p = 0.766), these muscle perfusion changes were not statistically significant. Postoperative complications, such as great toe clawing and donor site infection, were not observed.

CONCLUSIONS

Despite severe fibrosis within the FHL muscle after extensive dissection during fibula harvest and peroneal arterial ligation, the FHL muscle perfusion could be retained from an MRI perspective.

Evaluation of adherence to the Preferred Reporting of CasE Series in Surgery (PROCESS) 2020 guideline in case series describing endovascular management of vein of Galen malformation demonstrates suboptimal reporting practices

BACKGROUND

Interventional neuroradiology is a dynamic field with technological advancements constantly driving evolution in clinical practice. Case series provide interventional neuroradiologists the opportunity to describe the clinical implications of novel equipment and techniques almost in real-time, informing broader adoption and directing future research. Complete reporting in case series is vital in enabling readers to detect bias, determine the generalizability of results and replicate study methodology. The aim of this study was to assess the quality of reporting in case series describing endovascular management of vein of Galen malformations.

METHODS

A systematic search for case series describing endovascular management of vein of Galen malformations in paediatric patients was conducted using a previously published search strategy in Medline, Embase and Web of Science in February 2024. Screening and data extraction were performed by two independent reviewers with disagreements resolved by consensus discussion. Quality of reporting was assessed using adherence to the Preferred Reporting of CasE Series in Surgery (PROCESS) 2020 checklist.

RESULTS

We included 19 case series representing a broad range of approaches and endovascular techniques for management of vein of Galen malformations. Overall adherence to the PROCESS 2020 guideline was moderate with a mean of 7.0/13 (54%; range 5.2 - 9.7/13; SD 1.1) items reported. The most consistently reported items related to characteristics of the clinical cohort and details regarding the specific image-guided intervention(s) provided. Items relating to study design, source of funding, pre-intervention patient optimisation, clinical follow-up and potential complications and alternatives for novel techniques/devices were less frequently reported.

CONCLUSIONS

The quality of reporting in case series describing endovascular management of vein of Galen malformation is suboptimal. Measures to improve the quality of reporting in neurointerventional case series include mandating adherence to reporting guidelines in journal instructions for authors and requiring submission of completed copies of relevant reporting guidelines alongside manuscripts.

Intravesical foreign bodies in pediatric: A case report highlighting the critical role of psychosocial assessment and intervention

A 12-year-old female presented with lower abdominal pain and hematuria following the self-insertion of a pencil into her bladder. Imaging revealed a 10.2 cm radiopaque object, which was removed intact via cystoscopy. Postoperative recovery was uneventful, and psychiatric evaluation diagnosed mild depression, highlighting the need for integrated psychosocial intervention. This case underscores the critical importance of a multidisciplinary approach that combines medical and psychosocial care in the management of intravesical foreign bodies, particularly in pediatric populations. Proactive measures, including mental health education and early psychosocial support, are essential for prevention and recurrence mitigation.

The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study

BACKGROUND

The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD.

METHODS

An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008-2019) and physician-led air ambulance service (2019-2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS).

RESULTS

A total of 168 patients met inclusion criteria, average age 46 years (IQR 30-61), 77% male, median ISS 25 (IQR 17-29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31 minutes (IQR 20-42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7-10.9) vs. 2.4 (1.4-3.3), P < 0.001) and coagulopathic (43% vs. 15%, P = 0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P < 0.001). 24-hour transfusion was higher in CVD patients: 3 (0-8) vs. 0 (0-0) units, P < 0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P = 0.002), but in patients with AIS 5 there was no difference ( P = 0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome.

CONCLUSION

One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.

Retinal oculomics and risk of incident aortic aneurysm and aortic adverse events: a population-based cohort study

BACKGROUND

The asymptomatic onset and extremely high mortality rate of aortic aneurysm (AA) highlight the urgency of early detection and timely intervention. The alteration of retinal vascular features (RVFs) can reflect the systemic vascular properties, and be widely used as the biomarker for cardiovascular disease risk prediction. Therefore, we aimed to investigate associations of RVFs with AA and its progression.

METHODS

In this prospective population-based cohort study, participants with eligible fundus images and without a history of AA at recruitment were included for analysis. A fully automated Retina-based Microvascular Health Assessment System was used to quantify multidimensional RVFs including the branching angle, caliber, complexity, density, length, and tortuosity. Univariable and multivariable Cox regressions were used to estimate the association of RVFs with the incidence of AA and aortic adverse events (AAE). Furthermore, propensity score matching was performed to mitigate the confounding effects of baseline characteristics.

RESULTS

During a median follow-up of 11.0 years, 306 incident AA (164 with abdominal AA and 108 with thoracic AA) and 48 incident AAE were documented. In the fully adjusted model, the retinal arterial branching angle (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.99) and the central tendency and variability of minimum venular caliber were significantly associated with the risk of incident AA (HR 1.13-1.15), while the venular minimum angular asymmetry (0.48, 0.30 to 0.77) was significantly associated with the incidence of AAE. Moreover, specific alterations of RVFs were observed in different AA subtypes (caliber in abdominal AA [HR 1.21]; caliber [HR 1.21-1.28], complexity, length, and tortuosity [HR 0.77-0.82] in thoracic AA). Similar results were obtained after propensity score-matched analysis, confirming the stability of these associations.

CONCLUSIONS

We identified a significant association of certain RVFs with incident AA and AAE, implying that noninvasive, and convenient fundus photography could be a promising tool to facilitate the early detection of AA and subsequent preventative interventions.

Non-enhanced abbreviated MRI as a periodic surveillance protocol for colorectal liver metastases compared with contrast-enhanced CT: a prospective observational study

BACKGROUND

Adopting an appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process.

METHODS

587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7 days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, and paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared, and a subgroup analysis was performed in lesions with a size of ≤10 mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored.

RESULTS

The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than those of CE-CT ( P < 0.001, P < 0.001, P = 0.003, respectively). In the subgroup analysis of lesions ≤ 10 mm, NE-AMRI also performed better than CE-CT ( P < 0.001, P = 0.002, P = 0.005, respectively). The patient-based sensitivities, specificities, NPVs, and PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than those for CE-CT in each round ( P = 0.015, P = 0.045, P = 0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of the CE-CT protocol, but not on the NE-AMRI protocol.

CONCLUSION

NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side effects associated with ionizing radiation and contrast agents.

The influence of familiarity between the surgeon and their assistant on patient outcomes: a prospective observational cohort study

BACKGROUND

The inverse relationship between increased surgical team familiarity and reduced operative time is established, but its effect on patient outcomes remains uncertain.

MATERIALS AND METHODS

A prospective cohort study including operations by attending surgeons between 1 November 2020 and 31 December 2021 across fourteen surgical departments from four French university hospitals. Surgical team familiarity was measured as the cumulative number of previous operations performed by the same dyad of attending and assisting surgeons. Composite of adverse events within 30 days of surgery encompassed major surgical complication, unplanned reoperation, extended ICU stay, and death. We used multivariable generally estimated equations to model the association between patient outcomes and surgical team familiarity, using a logarithmic function. The model considered the clustering of operations within surgeons.

RESULTS

Our analysis included 8546 operations by 1109 surgical team dyads, involving 45 attending surgeons and 369 assisting surgeons. We observed a significant inverse association between surgical team familiarity and composite adverse events odds ratio [OR] 0.92 (95% confidence interval [95% CI] 0.87-0.98), major surgical complications OR 0.93 (95% CI 0.88-0.99), and unplanned reoperations OR 0.88 (95% CI 0.78-0.99), with non-significant trends observed for extended ICU stays OR 0.88 (95% CI 0.75-1.04) and deaths OR 0.87 (95% CI 0.74-1.03). Within the first 15 collaborations, this was illustrated by a reduction in the occurrence of composite adverse events from 23.0% (95% CI 22.1%-24.0%) to 16.5% (95% CI 14.1%-18.8%), major surgical complications from 21.3% (95% CI 20.3%-22.2%) to 15.3% (95% CI 13.0%-17.5%), unplanned reoperations from 8.8% (95% CI 8.6%-9.1%) to 5.2% (95%CI 4.2%-6.1%), extended ICU stays from 4.3% (95% CI 4.1%-4.5%) to 3.1% (95% CI 2.0%-4.1%), and deaths from 2.3% (95% CI 2.1%-2.5%) to 1.4% (95% CI 0.9%-1.8%).

CONCLUSIONS AND RELEVANCE

This study emphasizes that heightened familiarity among surgical teams is associated with a significant reduction in major adverse events. Building stable operating room teams should be a management priority to enhance patient outcomes.

Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study

BACKGROUND

Population ageing and cancer burden are important global public health problems that pose unprecedented threats to health systems worldwide. Frailty is a common health problem among elderly patients with cancer. In recent years, the use of prehabilitation to improve frailty has received widespread attention. Few studies have addressed the specific physiologic effects of prehabilitation on patients undergoing surgery.

METHODS

Frail elderly patients (aged at least 65 years) who underwent elective primary surgery for gastric cancer between September 2022 and October 2023 were included in this single-centre prospective cohort study and were categorized into multimodal prehabilitation or ERAS standard care groups. Prehabilitation, including physical and respiratory training, nutritional support and psychosocial treatment, was provided at least two weeks before gastrectomy. The primary outcome was functional status. Secondary outcomes included changes in indices of lipid metabolism, oxidative stress and chronic inflammation.

RESULTS

Over a 13-month period, 137 participants were assessed for eligibility, and 110 patients (prehabilitation 55, ERAS 55) were analysed. Compared with the baseline, patients in the prehabilitation group exhibited increased physical capacity before the operation (mean 6-min walk test change +28 m; P < 0.001). After prehabilitation intervention, inflammation-related indicators (NLR, PLR, SII and CRP) improved, and proinflammatory cytokine production (IL-5, IL-6, IL-1β, IL-10 and TNF-α) decreased. After surgery, the increase in IL-6 was reduced in the prehabilitation group (P = 0.036). Moreover, prehabilitation was associated with alleviating oxidative stress as determined by the levels of MDA (P = 0.005).

CONCLUSION

Multimodal prehabilitation can play a beneficial role in improving functional abilities by reducing chronic inflammation, improving lipid metabolism, and attenuating oxidative stress.

Spilled but Not Forgotten: A Retained Gallstone Leading to Colonic Fistula Formation

Laparoscopic cholecystectomy (LC) is a routinely performed procedure for symptomatic cholelithiasis, known for its minimal invasiveness and favorable outcomes; however, intraoperative gallbladder perforation and subsequent stone spillage can lead to rare but serious complications such as abscess formation and fistulization. A 38-year-old male patient with a history of sickle cell disease and prior LC presented multiple times with recurrent right upper quadrant (RUQ) pain and sepsis, and over the course of two years, imaging and endoscopic evaluations revealed persistent subhepatic abscesses with a fistulous tract involving the ascending colon. Intraoperative exploration ultimately uncovered a retained gallstone serving as the nidus of this chronic inflammatory process, and a laparoscopic right hemicolectomy with the removal of the stone was performed, leading to the resolution of the patient's symptoms. Although many retained gallstones remain clinically silent, a fraction present late with abscesses or fistulas, complicating diagnosis and increasing morbidity; therefore, comprehensive imaging studies, including CT scans and colonoscopy, are essential for identifying potential complications, and definitive surgical intervention is often required to remove the affected bowel segment and the offending stone. This case underscores the importance of meticulous intraoperative technique and vigilance in patients who develop unexplained or recurrent abdominal sepsis after LC, highlighting that early recognition of this rare complication can guide appropriate management and ultimately reduce the risk of severe morbidity.

Burden and attributable risk factors of non-communicable diseases and subtypes in 204 countries and territories, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Understanding based on up-to-date data on the burden of non-communicable diseases (NCDs) is limited, especially regarding how subtypes contribute to the overall NCD burden and the attributable risk factors across locations and subtypes. We aimed to report the global, regional, and national burden of NCDs, subtypes, and attributable risk factors in 2021, and trends from 1990 to 2021 by age, sex, and socio-demographic index (SDI).

MATERIALS AND METHODS

We used data from the Global Burden of Disease Study 2021 to estimate the prevalence, deaths, and disability-adjusted life years (DALYs) for NCDs and subtypes, along with attributable risk factors. Estimates were presented with 95% uncertainty intervals (UI). Relationships between NCD DALYs and SDI across regions and countries were estimated using smoothing splines models.

RESULTS

In 2021, NCDs accounted for 7.3 trillion global cases, 43.8 million deaths, and 1.73 billion DALYs. Global age-standardized rates showed NCD prevalence at 91 034.0, deaths at 529.7, and DALYs at 20 783.0 per 100 000 population, with changes of -0.1%, -27.9%, and -19.4% from 1990, respectively. Subtypes with the highest age-standardized DALYs were cardiovascular disease (5056), neoplasms (2954), and other NCDs (1913 per 100 000 population), with diabetes and kidney diseases increasing by 25.6% since 1990. Regionally, Oceania had the highest age-standardized DALYs (28 782.0) in 2021, while Southern Sub-Saharan Africa saw the largest increase (+8.0%) since 1990. Nationally, Nauru reported the highest age-standardized DALYs (42 754.3), with Lesotho experiencing the largest increase since 1990 (+38.4%). Cardiovascular diseases had the highest age-standardized DALYs among subtypes across 16 of 21 regions and 159 of 204 countries. Key risk factors globally were high systolic blood pressure (contributing to 12.8% of age-standardized DALYs), dietary risks (10.0%), and tobacco usage (9.9%), with the most significant increase in high body-mass index (+57.8%). High systolic blood pressure was the biggest attributable risk factor for NCDs in 9 regions and 101 countries. Age-standardized data reveal higher NCD prevalence in women and greater mortality and DALYs in men, with DALYs spiking post-45 for both sexes. Men have higher DALYs attributed to most risk factors, excluding those from unsafe sex, intimate partner violence, low physical activity, and high body-mass index. Age-standardized DALYs of NCDs generally decline with the SDI spectrum. Dominant NCD risk factors follow gender-age and SDI-based trajectories.

CONCLUSION

Despite declining age-standardized prevalence, death rates, and DALYs for NCDs, they remain a major health issue. Emphasis on managing cardiovascular diseases, cancers, diabetes, kidney diseases, and mental disorders is essential. The burden of NCDs is more severe in low-SDI countries and among males. Prevention efforts should prioritize blood pressure control, dietary improvements, and tobacco reduction, tailoring interventions according to gender-age-based and SDI-development-based trajectories of dominant risk factors.

Daily physical activity habits influence surgeons' stress in the operating room: a prospective cohort study

BACKGROUND

Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons' physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.

MATERIALS AND METHODS

This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.

RESULTS

We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42-55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Surgeon professors presented lower lnRMSSD (-0.437, -0.749 to -0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (-0.337, -0.646 to -0.027, P = 0.033), compared to their counterparts.

CONCLUSIONS

Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons' stress in the operating room.

A novel technique for rapid localization of pulmonary nodules on-site in operating room followed by lung resection: a case series

BACKGROUND

The localization of pulmonary nodules is crucial for surgical intervention. However, a safe, simple, and efficient method remains elusive. This study aims to evaluate the safety and feasibility of a newly developed preoperative localization method for pulmonary nodules called Rapid Localization of Pulmonary Nodules On-Site (RLPN-OS).

METHODS

This study is a single-center, single-arm prospective investigation that collects and analyses the clinical data of patients who underwent RLPN-OS and lung resection, primarily evaluating the safety and feasibility of this technique.

RESULTS

A total of 200 lung nodules from 190 patients who underwent RLPN-OS and partial lobectomy were included in this study. The success rate of localization was 98.0%, and minor intercostal bleeding was observed in 3 (1.5%) cases. All targeted lesions were located and resected successfully. No patients reported experiencing anxiety or pain during or after the procedure.

CONCLUSIONS

This novel RLPN-OS technology represents a safe, feasible, patient-friendly, and cost-effective method for lung nodule localization. It has the potential to serve as an alternative to traditional CT-guided percutaneous localization techniques.

Predictive Value of Viable Myocardium of Papillary Muscle-Ventricular Wall Complex for Improvement in Moderate Ischemic Mitral Regurgitation

Background

Performing a mitral valve procedure during coronary artery bypass grafting (CABG) in patients with coronary artery disease complicated by moderate ischemic mitral regurgitation (IMR) remains controversial. This study aimed to assess the benefit of isolated CABG and to develop a new index of viable myocardium within the papillary muscle-ventricular wall complex (VM-PM-VWC) to predict the improvement of IMR by CABG alone.

Methods

In total, 122 patients (age, 62.34 ± 8.53 years; 78.70% male) with moderate IMR who underwent CABG alone at Beijing Anzhen Hospital were retrospectively analyzed. All patients underwent 99mTc-sestamibi single-photon emission computed tomography (SPECT) and 18-fluorine fluorodeoxyglucose positron emission tomography (18F-FDG PET) to evaluate the VM-PM-VWC. Based on the postoperative echocardiography results at 1-year follow-up, patients were divided into IMR-unimproved (moderate or severe IMR, n = 38) and IMR-improved (no or mild IMR, n = 84) groups. Factors associated with improvement were analyzed by multivariate logistic regression.

Results

The VM-PM-VWC was an independent factor for moderate IMR improvement (odds ratio, 1.16; 95% confidence interval [CI], 1.09-1.24; P < 0.001). The cutoff value for moderate IMR improvement was 12.50%, with a sensitivity and specificity of 76.32% and 80.95%, respectively (area under the curve [AUC] 0.830; 95% CI, 0.741-0.919; P < 0.001). During a median follow-up of 3.71 (interquartile range: 2.17-5.10) years, major cardiovascular and cerebrovascular event-free survival was higher in the improved group than in the unimproved group (P < 0.001).

Conclusions

Most patients with moderate IMR improved from isolated CABG. The VM-PM-VWC was an independent predictor of IMR improvement, which could help surgical decision making.

Clinical Trial Registration

ChiCTR2100042454.

Assessment of simulation training efficacy in improving microsurgical skills: a retrospective analysis

BACKGROUND

Microsurgery demands an intensive period of skill acquisition due to its inherent complexity. The development and implementation of innovative training methods are essential for enhancing microsurgical outcomes. This study aimed to evaluate the impact of a simulation training program on the clinical results of fingertip replantation surgeries.

MATERIALS AND METHODS

A total of 276 replanted digits from 232 patients were included in this study, with a follow-up period of 6 months. Surgeons were identified and divided into trained and control groups, with the trained group receiving the rat tail training program. Primary outcomes included survival rates, replantation duration for each fingertip, degrees of flexion, Semmes-Weinstein monofilament test results, static two-point discrimination scores, Michigan Hand Questionnaire (MHQ) scores, and the incidence rates of complications such as arterial insufficiency and pulp atrophy.

RESULTS

Out of 1191 patients screened, 232 met the criteria for analysis. The average patient age was 41.3 years, predominantly male (87.1%). Trained microsurgeons performing Zone 1A replantation had higher success rates, shorter surgery durations, and fewer arterial complications compared to their untrained counterparts. For Zone 1B, they also showed improved operation times, decreased venous congestion and pulp atrophy, and better sensation outcomes. The results of trained group remained consistent across both single and multiple replantation, while the control group's outcomes varied in multiple replantation with less favorable results. The trained group reported better scores on the MHQ at 6-month follow-ups, particularly regarding work performance, pain levels, aesthetics, and satisfaction.

CONCLUSIONS

The simulation training program using a rat tail model has proven effective in enhancing the skills necessary for improved fingertip replantation. Participants in the program performed surgeries more efficiently and achieved better clinical outcomes. The structure of the training has demonstrated benefits, which may lead to improvements in various microsurgical procedures, positively impacting trainee surgeons, patient care, and the broader medical community.

Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series

STUDY DESIGN

Retrospective Case-Series.

OBJECTIVES

Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients.

METHODS

A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered "lordosing" if the change in postoperative SL was ≥ +4° and "kyphosing" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression.

RESULTS

A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P < .001) and NRS-BP (3.3 ± 3 point improvement, P < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P < .001) while LL (Δ0.17° ± 6.98°, P > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P = .001, β = 15.06° P < .001, respectively).

CONCLUSIONS

In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.

Environmental responsibility in resource utilization during the practice of regional anesthesia: a Canadian Anesthesiologists' Society Delphi consensus study

PURPOSE

Regional anesthesia (RA) is often perceived to be more environmentally sustainable than alternative forms of anesthesia. Nevertheless, the principles of sustainable RA remain ill-defined in the presence of variability of resource utilization within RA practice. Many infection prevention practices are based on low-level evidence, and recommendations vary internationally. We sought to conduct an evidence review and Delphi consensus study to provide guidance on aspects that lack high-quality evidence in RA practice to reconcile responsible resource stewardship and infection prevention in RA.

METHODS

We conducted a three-round modified Delphi process. After distributing an initial free-text questionnaire to all collaborators, we created structured questions, followed by two rounds of anonymized voting. We defined strong consensus as ≥ 75% agreement and weak consensus as ≥ 50% but < 75% agreement.

RESULTS

Forty-six experts agreed to take part in the study and 36 (78%) completed all the voting rounds. Regional anesthesia practice parameters with strong consensus included hand hygiene using alcohol scrub rather than soap and water, sterile gowns being unnecessary for single-injection RA techniques, only minimal equipment in the premade packs, and goal-directed use of sedation and supplemental oxygen.

DISCUSSION

We obtained consensus on the safe and environmentally responsible practice of RA for both single-injection and indwelling catheter techniques and identified areas of research focus. While more robust evidence is being generated, clinicians may use these findings as a guide to infection prevention and environmental sustainability in their anesthesia practice.

Bots in white coats: are large language models the future of patient education? A multicenter cross-sectional analysis

OBJECTIVES

Every year, around 300 million surgeries are conducted worldwide, with an estimated 4.2 million deaths occurring within 30 days after surgery. Adequate patient education is crucial, but often falls short due to the stress patients experience before surgery. Large language models (LLMs) can significantly enhance this process by delivering thorough information and addressing patient concerns that might otherwise go unnoticed.

MATERIAL AND METHODS

This cross-sectional study evaluated Chat Generative Pretrained Transformer-4o's audio-based responses to frequently asked questions (FAQs) regarding six general surgical procedures. Three experienced surgeons and two senior residents formulated seven general and three procedure-specific FAQs for both preoperative and postoperative situations, covering six surgical scenarios (major: pancreatic head resection, rectal resection, total gastrectomy; minor: cholecystectomy, Lichtenstein procedure, hemithyroidectomy). In total, 120 audio responses were generated, transcribed, and assessed by 11 surgeons from 6 different German university hospitals.

RESULTS

ChatGPT-4o demonstrated strong performance, achieving an average score of 4.12/5 for accuracy, 4.46/5 for relevance, and 0.22/5 for potential harm across 120 questions. Postoperative responses surpassed preoperative ones in both accuracy and relevance, while also exhibiting lower potential for harm. Additionally, responses related to minor surgeries were minimal, but significantly more accurate compared to those for major surgeries.

CONCLUSIONS

This study underscores GPT-4o's potential to enhance patient education both before and after surgery by delivering accurate and relevant responses to FAQs about various surgical procedures. Responses regarding the postoperative course proved to be more accurate and less harmful than those addressing preoperative ones. Although a few responses carried moderate risks, the overall performance was robust, indicating GPT-4o's value in patient education. The study suggests the development of hospital-specific applications or the integration of GPT-4o into interactive robotic systems to provide patients with reliable, immediate answers, thereby improving patient satisfaction and informed decision-making.

Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series

BACKGROUND

Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues.

METHODS

Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique.

RESULTS

The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC).

CONCLUSIONS

Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure.

KEY POINTS

Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.

Recurrence and survival after robotic vs laparoscopic liver resection in very-early to early-stage (BCLC 0-A) hepatocellular carcinoma

BACKGROUND

Robotic (RLR) and laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) provide similar short-term outcomes, but data focused on recurrence and survival are still lacking. We hypothesized non-inferior oncologic results of RLR compared to LLR for HCC of stage BCLC 0-A.

METHODS

RLRs and LLRs on patients with HCC of stage BCLC 0-A and preserved liver function (Child A or B if cirrhosis) were retrospectively reviewed. Propensity score matching (PSM) was used to mitigate selection bias. The primary endpoints were recurrence-free (RFS) and overall survival (OS); secondary endpoints were incidence, pattern, and treatment of recurrences.

RESULTS

After 1:1 PSM, two groups (RLR = 68; LLR = 68) of patients with similar characteristics, liver function and HCC features were obtained: median age 71-years, males 73.5%, underlying cirrhosis 91.2% (Child A, 96.8%, MELD ≤ 9, 96.0%), portal hypertension 22.1%, single-HCC 90.4%. Two- and 5-year RFS were 78.0 vs 59.0% and 54.0 vs 53.0% (p = 0.107), while OS was 97.0 vs 90.0% and 87.0 vs 90.0% (p = 0.951) for RLR vs LLR, respectively. Incidence of HCC recurrence was similar (35.3 vs 39.7%; p = 0.723). Recurrences developed mostly within the liver (29.4 vs 30.9%; p = 1.000) and within 2 years after hepatectomy (19.1 vs 32.4%, p = 0.116) in RLR vs LLRs. Curative-intent treatment of recurrences did not differ (liver transplantation 19.6%, redo-resection 15.7%, locoregional treatments 52.9%) except for a tendency toward more redo-resections for recurrences after RLR.

CONCLUSIONS

Oncologic outcomes of RLR were not inferior to those of LLR in selected HCC patients of stage BCLC 0-A with underlying cirrhosis. Both techniques guaranteed similar salvageability in case of HCC recurrence.

Characterization changes and research waste in randomized controlled trials of global gastroesophageal reflux disease and hiatus hernia over the past 20 years

BACKGROUND

The results of many large randomized clinical trials (RCTs) have transformed clinical practice in gastroesophageal reflux disease (GERD) and esophageal hiatal hernia (HH). However, research waste (i.e., unpublished data, inadequate reporting, or avoidable design limitations) remains a major challenge to evidence-based medicine.

METHOD

A cross-sectional analysis was conducted to comprehensively review and evaluate RCTs related to GERD and esophageal HH, registered in the ClinicalTrials.gov database between 2003 and 2023. A sample of eligible RCTs was identified by excluding early-stage trials, pediatric studies, and duplicate studies. Publication status was tracked using PubMed and Scopus databases, reporting adequacy was assessed according to the CONSORT guidelines, and design flaws were checked with the help of Cochrane tools. Shortcomings of RCT studies in different regions and intervention types were identified by quantifying RCT conduct, recruitment, reporting adequacy, risk of bias, and guideline citations.

RESULTS

From 2003 to 2023, a total of 182 RCTs were included in the analysis, of which 69.8% (127 trials) were drug-related, and 71.4% of the principal investigators were located in North America and Asia (65 trials [35.7%] in both). Among them, the country with the most RCTs is the United States. RCTs in Asia were under-conducted in "procedure" and "other" types and fewer RCTs were conducted in Europe in "drug" type. RCTs in Oceania and South America were relatively under-conducted in the device and "other." The study revealed that more than 86.7% of RCTs were characterized by at least one type of research waste. Research waste was associated with the size of the RCT, blinded design, and regional healthcare access and quality index.

CONCLUSIONS

This study describes for the first time the characteristics of RCTs for GERD and esophageal HH over the past 20 years and the conduct of various types of RCTs at the continental level. It identifies the burden of research waste and shortcomings in the conduct of RCT programs on each continent, which may provide evidence for the development of rational RCTs and the reduction of waste in the future.

Global, regional, and national burden of gallbladder and biliary tract cancer, 1990 to 2021 and predictions to 2045: an analysis of the Global Burden of Disease study 2021

BACKGROUND

Identifying past, present, and future temporal trends in gallbladder and biliary tract cancer (GBTC) can increase public awareness and promote changes in prevention and treatment strategies.

METHODS

The incidence and death rates of GBTC between 1990 and 2021 were extracted from the Global Burden of Disease study 2021 and assessed according to country, region, year, age, and sex. Time trends were measured using the average annual percentage change (AAPC) and projections of the burden of disease for 2022 to 2045 were made using the Bayesian age-period-cohort model.

RESULTS

In 2021, there were 216,768.3 new cases (95% uncertainty interval [UI], 181,888.0-245,237.6) and 171,961.2 deaths (95% UI, 142,351.8-194,238.4) in GBTC globally. The increases in incidence and deaths were 101.09% and 74.26%, respectively, compared with 1990. The GBTC burden was higher in females and older adults. However, age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) trended downward from 1990 to 2021, with AAPC at -0.39 (95% CI, -0.52 to -0.26) and -0.88 (95% CI, -0.96 to -0.79), respectively. Although the ASIR and ASDR for both sexes are projected to decline gradually from 2022 to 2045, the incidence and deaths are expected to increase steadily. In addition, the global proportion of GBTC deaths owing to high body mass index in 2021 was 12.66% for females and 10.48% for males, which did not change significantly from 1990.

CONCLUSION

GBTC is becoming a major global health burden, especially among females and older adults. Given the increasing burden of an aging population, there is a need to reduce the incidence of this disease by adopting effective strategies and measures targeting risk factors.

Maxillary sinus augmentation via the bone lid technique: A prospective, radiographic case series

BACKGROUND

Maxillary sinus augmentation is one of the most performed procedures to increase the bone quantity of the atrophic maxilla to allow implant placement. The aim of the present case series was to describe a surgical protocol to perform maxillary sinus augmentation with the "bone lid technique," and its outcomes in a cohort of patients eligible for the procedure.

METHODS

After the initial clinical evaluation, a cone-beam computed tomography (CBCT) examination was performed for preoperative assessment. Patients were then scheduled for surgical intervention. At 6-9 months follow-up, patients underwent a second CBCT scan to evaluate bone height following bone graft and to schedule implant placement.

RESULTS

A total of 11 patients were enrolled in the study with a total of 13 sinus lift procedures. Membrane perforation was registered in 4 cases (30.76%). Mean surgical time was 67.69 min (SD 6.51). Postoperative period was uneventful in all patients, in the absence of complications. The mean graft volume increase was 2.46 cm3 (SD 0.85), and the mean height increase was 14.27 mm (SD 3.18). Mean membrane thickness was 1.40 mm (SD 0.75). In all the 4 cases with sinus membrane perforation, the membrane had a thickness lower than 1 mm.

CONCLUSIONS

The present study highlights that the maxillary sinus augmentation with bone lid repositioning could provide repeatable results in terms of bone height increase. The technique appears reliable both in terms of bone gain and absence of complications.

KEY POINTS

The bone lid technique for maxillary sinus augmentation provides repeatable results in terms of bone height increase. The favorable clinical outcomes can be related to an enhancement of bone formation due to the unique osteoconductive and osteoinductive properties of autogenous bone, along with a reduction of soft tissue ingrowth. Complications were not observed in any of the patients following the surgical procedures. The risk of Schneiderian membrane perforation is inversely proportional to membrane thickness; the thinner the membrane is, the higher the risk to perforate it.

Low Back Pain Incidence Trends Globally, Regionally, and Nationally, 1990-2019: An Age-Period-Cohort Analysis, Cross-Sectional Studies

INTRODUCTION

Low back pain (LBP) imposes a significant burden on global health, yet it remains deficient in comprehensive investigations pertaining to its incidence patterns. The aim of this study was to analyse global, regional and national trends and associated factors in the incidence of LBP from 1990-2019.

METHODS

In order to examine global and country-specific 30-year incidence patterns of LBP, data were obtained from the 2019 Global Burden of Disease Study. An age-period cohort (APC) model was utilised to determine annual percent changes, age-specific changes, and period/cohort effects.

RESULTS

The age-standardized global LBP incidence rate significantly declined from 1990-2019. However, the absolute number of cases increased by 2.39 billion, predominantly in middle-, low-middle- and low-socio-demographic index (SDI) regions, affecting mostly 50-69 years old with a higher incidence in women. LBP incidence increased progressively from low to high SDI regions. Period and cohort effects trended downward in all regions except high-SDI countries, which had the lowest incidence decline and a slight rebound after 2012.

CONCLUSIONS

Our study updates global and regional LBP incidence from 1990-2019 using APC modelling, showing declining age-standardized rates globally but increased case numbers due to population growth and ageing. Prevention likely helped reduce incidence, but more health strengthening and minimally invasive treatments are still needed, especially where LBP has plateaued or rebounded recently.

Effect of Adjuvant Chemotherapy Cycles on Patients with Node-Negative Gastric Cancer Following Neoadjuvant Chemotherapy: Multicenter Cohort Study

BACKGROUND

Research investigating the potential impact of postoperative adjuvant chemotherapy cycles on patients with lymph node-negative gastric cancer following neoadjuvant chemotherapy is currently sparse. This study aims to explore the effect of adjuvant chemotherapy cycles on the prognosis of this specific patient group.

PATIENTS AND METHODS

We analyzed clinicopathological data from patients at four institutions between 2010 and 2020. Independent risk factors associated with 3-year overall survival (OS) were identified using a Cox proportional hazards regression model.

RESULTS

We enrolled a total of 219 patients in this study. Patients with lymph node-negative gastric cancer who received neoadjuvant chemotherapy and underwent at least five cycles of adjuvant chemotherapy (AC ≥ 5) after surgery had a significantly higher 3-year overall survival rate of 86.8% compared with those who received fewer than five cycles (AC < 5) with a survival rate of 68.1% (P = 0.016). Multivariate analysis identified several factors, including AC ≥ 5 (HR 0.367, 95% CI 0.166-0.815, P = 0.014), ypT stage ≥ 2 (HR 2.779, 95% CI 1.199-6.438, P = 0.017), and poorly differentiated tumors (HR 2.501, 95% CI 1.385-4.517, P = 0.002), as independently associated with 3-year OS in this patient group. Stratified analysis further revealed that AC ≥ 5 significantly enhanced long-term outcomes in patients with ypT stage ≥2 (3-year OS, 82.5% vs. 62.6%, P = 0.025) and in those with poorly differentiated tumors (3-year OS, 82.6% vs. 53.3%, P = 0.021).

CONCLUSION

Patients who have lymph node-negative gastric cancer following neoadjuvant chemotherapy, with either ypT stage ≥ 2 or poorly differentiated gastric cancers, may experience benefits from undergoing at least five cycles of adjuvant chemotherapy.